Schulman C C
Department of Urology, University Clinics of Brussels, Erasme Hospital, Belgium.
Prostate Suppl. 1994;5:9-14. doi: 10.1002/pros.2990250705.
The treatment of locally advanced prostatic cancer is controversial, as there are several possible treatment options. The aims of temporary androgen deprivation prior to radical prostatectomy are to achieve downgrading and downstaging of the tumor, an increase in local control, a decrease in morbidity and operative sequelae, a decrease in the time to progression, and an improvement in survival. A retrospective study has been carried out on 100 patients who underwent radical prostatectomy between 1988 and 1992. Forty patients received androgen deprivation therapy followed by prostatectomy, while the remaining 60 acted as controls, undergoing prostatectomy alone. Treated patients had a 40-50% reduction in prostate volume after 3 months, facilitating dissection of the prostate, reducing intraoperative blood loss, and reducing operation time. Of these 40 treated patients, one third showed clinical downstaging; one patient staged initially as T2/B was downstaged to PT0. The proportion of patients with positive surgical margins was 32% in the group treated preoperatively, compared with 57% in untreated patients. Treated patients also recovered full continence more rapidly after the operation than patients who underwent prostatectomy alone. After androgen blockade, serum PSA levels returned to normal (< 4 ng/ml) in 37 of the 40 patients. Of these patients, 22 had undetectable serum PSA levels (< 0.25 ng/ml), showing a definite reduction in tumor activity. PSA levels after 3 months of neoadjuvant hormonal treatment might play a useful predictive role in selecting patients before radical prostatectomy, since 86% with undetectable PSA had tumors confined to the gland (T2/B2), while patients who still had PSA > 4 ng/ml all had stage T3-T4 tumors. Although downstaging was confirmed pathologically in only 13% of patients, this is of significance when the total number of patients with locally advanced prostate cancer is considered and, therefore, may have implications for survival in the future. Prospective randomized studies should provide conclusive information on the potential benefit of this approach.
局部晚期前列腺癌的治疗存在争议，因为有几种可能的治疗选择。根治性前列腺切除术前行短期雄激素剥夺治疗的目的是实现肿瘤降度和降期，提高局部控制率，降低发病率和手术后遗症，缩短疾病进展时间，并改善生存率。对1988年至1992年间接受根治性前列腺切除术的100例患者进行了一项回顾性研究。40例患者接受雄激素剥夺治疗后再行前列腺切除术，其余60例作为对照组，仅接受前列腺切除术。接受治疗的患者在3个月后前列腺体积减少了40%-50%，便于前列腺的解剖，减少术中失血，并缩短手术时间。在这40例接受治疗的患者中，三分之一出现临床降期；1例最初分期为T2/B的患者降期至PT0。术前治疗组手术切缘阳性患者的比例为32%，而未治疗患者为57%。与仅接受前列腺切除术的患者相比，接受治疗的患者术后恢复完全控尿的速度也更快。雄激素阻断后，40例患者中有37例血清PSA水平恢复正常（<4 ng/ml）。在这些患者中，22例血清PSA水平检测不到（<0.25 ng/ml），显示肿瘤活性明显降低。新辅助激素治疗3个月后的PSA水平可能在根治性前列腺切除术前行患者选择中发挥有用的预测作用，因为PSA检测不到的患者中有86%的肿瘤局限于腺体（T2/B2），而PSA>4 ng/ml的患者均为T3-T4期肿瘤。尽管只有13%的患者经病理证实出现降期，但考虑到局部晚期前列腺癌患者的总数时，这具有重要意义，因此可能对未来的生存率产生影响。前瞻性随机研究应能提供有关这种方法潜在益处的确切信息。
